Healthcare Provider Details

I. General information

NPI: 1093213639
Provider Name (Legal Business Name): MIA OBOYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MAGNOLIA DR
CHESTER SPRINGS PA
19425-3611
US

IV. Provider business mailing address

124 KITTERY CT
SELLERSVILLE PA
18960-2153
US

V. Phone/Fax

Practice location:
  • Phone: 610-389-6191
  • Fax:
Mailing address:
  • Phone: 215-767-2289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC014460
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: